Healthcare Provider Details

I. General information

NPI: 1891018016
Provider Name (Legal Business Name): ATLANTA MEDICAL CLINIC L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 14TH ST NW STE 300
ATLANTA GA
30318-7818
US

IV. Provider business mailing address

197 14TH ST NW STE 300
ATLANTA GA
30318-7818
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-8837
  • Fax: 678-244-2155
Mailing address:
  • Phone: 404-872-8837
  • Fax: 678-244-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. HUNTER TULLY
Title or Position: CEO
Credential:
Phone: 954-621-6887